[Openid-specs-heart] Draft HEART Meeting Notes 2015-08-10

Aaron Seib aaron.seib at nate-trust.org
Tue Aug 11 13:34:58 UTC 2015


I am confused or might have a friendly amendment for what you are trying to communicate.

 

Are you positing to the group that item (3) is out of scope because it is an Identity Federation feature and by definition not part of the charter of the HEART project?

 

If that is what you are saying could you please tell me who is working on enabling the inclusion of the PCP’s Identity Proofing of Alice in determining the level of assurance associated with her accounts (in any system – PHR, EMR or the portals thereof)?

 

This is what I am trying to discover.  When the PCP has a patient-provider relationship established with Alice and he is provide with Alice’s URL to her AS I am very interested in how we can reuse this ID proofing event to increase the level of assurance associated with Alice’s AS.  There are many ways to remote Identity proof Alice that have cost associated with them.  If we can capture the ID Proofing event (I assume that a URL and some unique Identifier related to Alice is required in the HEART transactions when Alice has her privacy preferences configured in an AS that has multiple users) from when the PCP trust the URL/GUID associated with Alice for an AS it would create value too.

 

In other words – how do we make it possible for relying parties other than Alice’s PCP to discover that her PCP has come to trust the binding of Alice’s Identity to a specific URL/ID for her AS?

 

Is that being discussed anywhere other than the HEART project?  

 

 

Aaron Seib, CEO

@CaptBlueButton 

 (o) 301-540-2311

(m) 301-326-6843



 

From: Openid-specs-heart [mailto:openid-specs-heart-bounces at lists.openid.net] On Behalf Of Adrian Gropper
Sent: Monday, August 10, 2015 7:33 PM
To: Kinsley, William
Cc: openid-specs-heart at lists.openid.net
Subject: Re: [Openid-specs-heart] Draft HEART Meeting Notes 2015-08-10

 

(Proposed) Problem Statement (for HEART EHR-PHR Use Case:

This use-case is designed to (1) enable automated update of Alice's PHR when new findings or orders are entered by the physician or practice staff into the practice's EHR; (2) to enable messaging with attached documents from the practice's EHR via Alice's PHR; and (3) to enable _________ by allowing the practice to identity proof Alice's persona as authenticated by Alice's PHR.

Discussion of proposed problem statement:

I think I understand the intent, but I'm having a difficult time coming up with a transaction that would be enabled or even enhanced by (3). The intent could be to enhance an un-tethered PHR like Microsoft HealthVault or a health information exchange that don't have an in-person relationship with Alice in case Alice loses her password and forgets her secret questions. In that case, Alice could presumably go to her PCP's office or any other practice that is federated with the PHR or HIE and present a verified ID to reclaim control of her PHR account. As Sarah points out in her comment, this is a federation use-case outside the scope of HEART. 

Another possible intent could be to enhance the ability for another practice, for example the Quest Lab used by the PCP, to share results with Alice or Alice's PHR through the lab's portal or FHIR interface. This is another situation where the other practice, the Lab, has no in-person relationship with Alice. It's another example of federation because the Lab would have to be federated with the PHR host in order to trust that indeed, the identity proofing was done. I'm not sure how this would work. There's obviously trust between the PCP and the Lab because the PCP sent the order to the Lab directly under the HIPAA TPO exemption but the PHR is another matter.

It would be nice if the PCP could send the order to the Lab via the PHR. This would be even more valuable in the case of e-prescribing because Alice would then have the opportunity to shop various pharmacies using, for example GoodRX. With today's EHRs, Alice has lost this ability to shop around except if the EHR prints a paper prescription or lab order. The value of shopping around, in the case of orders for an expensive test such as an MRI can be over $1,000. To enable this benefit, the EHR would have to (a) digitally sign the order and optionally (b) in the case of a controlled substance prescription, identity proof Alice so that the pharmacy can check her ID when she comes to pick up her prescription. Digitally signing the order or prescription (a) before sending it to the PHR under case (1) or (2) above has nothing to do with HEART and may be considered a federation or trust framework issue anyway.

Although identity proofing could be valuable for giving Alice access to the portals of labs, pharmacies, and health information exchanges this is purely a matter of federation and doesn't have directly to do with FHIR, OAuth, or UMA. I suggest there is no Problem (3).

The relationship between FHIR and Problem (1) and Problem (2) is yet another matter. I suggest we take that up as part of the scopes discussion once we have finalized the Problem Statement.

 

Adrian

 

 

On Mon, Aug 10, 2015 at 5:21 PM, Sarah Squire <sarah at engageidentity.com> wrote:

Most of the discussion was captured in the use case document itself, but I noted the discussion topics here as well just for future reference.

 

Attending:

 

Debbie Bucci

Sarah Squire

Danny van Leeuwen

Andy Oram

Robert Horn

Mark Russell

William Kinsley

Eve Maler

Adrian Gropper

Glen Marshall

Andrew Hughes

Corey Spears

Tom Sullivan

Abbie Barbir

Thomas Hardjono

Justin Richer

Edmund Jay

Catherine Schulten

Chad Evans

 

Next steps:

 

We will continue to address this use case next week.

 

Notes:

 

We worked on closing out issues on the enrollment use case document:

 

 <https://docs.google.com/document/d/1IvbdWerdvMuA1dQ-KQvVKqIBrAas7FoenNVUtgpqYrw/edit> https://docs.google.com/document/d/1IvbdWerdvMuA1dQ-KQvVKqIBrAas7FoenNVUtgpqYrw/edit

 

Are registration and enrollment interchangeable?

 

Registration is being used for Alice to enroll with both her doctor’s practice and the practice’s patient portal. We could use registration to mean practice registration and enrollment to mean EHR enrollment. When we use the term “known to the practice” it means that the practice has seen or heard from the patient and the practice has checked for insurance eligibility. A patient can be enrolled into an EHR by a staff member or they can enroll themselves. We decided to use the term “register” in the title rather than enroll since we are referring to the practice.

 

The PHR and EHR already have an established relationship in this use case so that we do not have to address dynamic registration or service discovery. We have made the decision not to address this problem so that we can focus on other technical questions.

 

Acknowledgement of receipt of privacy practices is peripheral.

 

We have removed the waiting room step since it has been captured in previous steps.

 

We confirmed that the doctor does record the results of the physical examination directly into the EHR without any sort of later transcription.

 

We should not use the word “results” with regard to a physical exam. We should use the phrase “clinical findings.”

 

The lab results are peripheral but have been included so that we can come back to them later.

 

The lab results should also include patient instructions such as fasting - this is also peripheral.

 

The problem statement is to autoupdate through the PHR and message through the PHR.

 

Sarah Squire

Engage Identity

 <http://engageidentity.com/> http://engageidentity.com


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-- 

 

Adrian Gropper MD

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